Before the surgery:
Pre-op visit – Once you’ve decided to proceed with the surgery, we will need to set up a pre-operative visit so that we can go over all the details of the surgery. We will need to do a detailed history and physical to identify any medical problems that you may have. Please bring a list of all of your medications, allergies, doctors, etc.
Blood Work and Medical Clearances – Before surgery we will need to get some blood work and depending on any health problems we may also need a note from your regular physician or heart doctor. The blood work is usually done at Brookwood Hospital in P.A.T. (Pre-Admission Testing, p: 802-6888).
Blood Thinners – If you take a blood thinner (i.e. Plavix, Coumadin, Aspirin, Pletal, and Ticlid just to name a few) you will need to stop it about a week to 10 days before the procedure. This may require checking with the prescribing physician to ensure that they’re aware of your upcoming surgery and your need to stop the medicine for this length of time.
Anti-inflammatory medications – In an effort to decrease your post operative pain and limit the amount of pain medication needed we may give you a prescription for a strong anti-inflammatory called Celebrex. Take 2 pills the morning of surgery with a small sip of water. After this initial dose, then take one pill a day until your prescription is gone (if you are allergic to sulfa, please let us know and we will swap you to a different medication).
Furniture – You will probably be sent home with a walker. Before surgery is a good time to make sure your house is set up in a way that you can get around easily with the walker. Also, pick up any throw rugs that may be easy to trip over with the walker. Some patients have even found it helpful to install hand railings in the bathroom to help with the transition from the hospital to home.
Hospital Stay – usually 2-3 nights
Pain medicine – Following your surgery we will either put you on a pain pump that you can control yourself or pain medicines through your IV that the nurse will give to keep you comfortable. Usually after 24 hours we’ll swap you over to pain medicine by mouth to find a medicine that works well that we can send home with you.
Wound care – Initially after surgery you will have an initial compressive dressing which will stay on 2 days; after that we will change it to a much lighter, smaller dressing. The nurse will teach you how to do daily dressing changes after this as well as help you shower if desired. If you were given stockings, you will need to wear theses daily until your follow-up visit. Stockings only need to be worn when you are sitting up or walking and traveling. They prevent swelling and blood clots.
Physical Therapy – The physical therapist will see you after your surgery to begin your exercises. They will get you out of bed, help you learn to use the walker, and then slowly help you increase how far you can walk. An occupational therapist will also help you learn how to do your activities of daily living, including dressing, showering, etc. In-between your therapy sessions we would like you to alternate elevating your leg to help decrease swelling as well as propping the leg out straight to work on extension; the therapist will show you how to do this.
Blood Thinner – You will be put on a medicine that thins your blood for protection against blood clots. We will give you a prescription upon discharge and your family will need to make sure to pick this up from your pharmacy.
Home needs – A Case Manager will meet with you following the surgery concerning any home needs you may have (walker, bedside commode, elevated commode attachment, shower chair, therapy, etc). Once you have told her your home situation, she will order what you need and have it either sent to your home or dropped off in the hospital room. If you do not have enough help at home you may need a short stay at a rehab or skilled nursing facility to increase your strength prior to returning home. The case manager in the hospital will check with your insurance and discuss with you your options.
Follow up visit – Please call within 24 hours of discharge for your appointment (870-1498), which should be set about 12 – 14 days from the date of your surgery. If you go to a rehab or skilled nursing facility you may delay your follow-up clinic appointment until after you return home (these facilities will most likely remove your sutures and communicate your progress to us.)
Wound care – Showering is O.K., just make sure that someone is around to help you. Do not soak your incision in any standing water (bathtub, hot tub, pools, etc) until your sutures are removed and permission given. You do not have to cover your incision with anything while showering; just clean the incision with alcohol or Betadine afterwards and redress with a bandage. If you were given stockings you will need to wear these daily until your follow-up visit. Avoid using any ointments like Neosporin for 2-3 weeks.
Physical Therapy – If you have chosen home physical therapy, the therapist usually will come about twice a week. They will also give you “homework” exercises to do when they’re not there which will help with your recovery and strengthen your leg. After about two weeks of home physical therapy, we recommend swapping over to our outpatient facility in Homewood if possible or we’ll find a location that is convenient for you.
Swelling control – If you had a knee replacement, elevate your leg multiple times a day with your toes above your nose. Your recliner is not the best place to do this; try the couch or bed. If you had a hip replacement, it may be comfortable to prop your leg on an ottoman or place a pillow under your hip to take pressure off.
Leg position – If you had a knee replacement, try to place a rolled up towel under your heel every couple of hours to work on letting your leg straighten all the way; do not place anything under the knee when doing this. If you had a hip replacement the therapist will teach you “hip precautions” which protects you from dislocating your new hip. This typically means avoiding low chair or bending your hip greater than 90 degrees. Also it is helpful to sleep with a pillow between your legs to keep your hip in proper position.
Pain medicine – Make sure to take your medicine; it’s harder to get the discomfort back under control once it’s out of control. Call our office if you need a refill, though not all medications can be called in; make sure to leave us a pharmacy number to call it in to (no medications will be called in after 2:00 pm Monday through Thursday or after 12:00pm on Friday).
Concerns – Please call the office immediately if you have any concerns; including a fever greater than 101.2 that doesn’t respond to Tylenol, excessive drainage, redness around the incision, or severe calf pain. 205.870.1498